Can you trust patient self-reports of drug use during treatment?

Zanis, David A.; McLellan, A. Thomas; Randall, Mary

doi:10.1016/0376-8716(94)90119-8

Cited by 96 publications

(66 citation statements)

References 16 publications

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“…Of the urine specimens collected at the 28-day and 84-day follow-up, only 7.5% indicated recent drug use when the participant denied use of their primary drug within the past 3 days. This rate compares favorably with previous studies of substancedependent samples which have supported the accuracy of self-report data using the methods described here (Zanis et al, 1994;Hersh et al, 1999;Ehrman and Robbins, 1994).…”

Section: Procedures and Assessmentssupporting

confidence: 90%

“…For example, because this was an effectiveness study, it was not feasible to monitor substance use via urine and breath specimen samples more frequently than at the major assessment points (baseline, 28-day, and 84-day follow-up) and thus substance use outcomes are based primarily on self-report. However, multiple methods previously demonstrated to enhance the validity of self-reports in clinical trials with substanceusing populations were used (Brown et al, 1992;Babor et al, 2000;Darke, 1998;Maisto et al, 1990;Zanis et al, 1994), including assurances to participants that their self-reports were confidential, independence of clinical program versus research assessments, use of the Timeline Followback method, and confirmation of participant self-reports with results of urines and breath specimens. In addition, as an effectiveness study, the time spent in training was not balanced across conditions, and clinicians assigned to MI received more training and supervision throughout the trial by design.…”

Section: Discussionmentioning

confidence: 99%

See 1 more Smart Citation

Motivational interviewing to improve treatment engagement and outcome in individuals seeking treatment for substance abuse: A multisite effectiveness study

Carroll¹,

Ball²,

Nich³

et al. 2006

Drug and Alcohol Dependence

412

347

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Despite recent emphasis on integrating empirically validated treatment into clinical practice, there are little data on whether manual-guided behavioral therapies can be implemented in standard clinical practice and whether incorporation of such techniques is associated with improved outcomes. The effectiveness of integrating motivational interviewing (MI) techniques into the initial contact and evaluation session was evaluated in a multisite randomized clinical trial. Participants were 423 substance users entering outpatient treatment in five community-based treatment settings, who were randomized to receive either the standard intake/evaluation session at each site or the same session in which MI techniques and strategies were integrated. Clinicians were drawn from the staff of the participating programs and were randomized either to learn and implement MI or to deliver the standard intake/evaluation session. Independent analyses of 315 session audiotapes suggested the two forms of treatment were highly discriminable and that clinicians trained to implement MI tended to have higher skill ratings. Regarding outcomes, for the sample as a whole, participants assigned to MI had significantly better retention through the 28-day follow-up than those assigned to the standard intervention. There were no significant effects of MI on substance use outcomes at either the 28-day or 84-day follow-up. Results suggest that community-based clinicians can effectively implement MI when provided training and supervision, and that integrating MI techniques in the earliest phases of treatment may have positive effects on retention early in the course of treatment.

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Section: Procedures and Assessmentssupporting

confidence: 90%

Section: Discussionmentioning

confidence: 99%

Motivational interviewing to improve treatment engagement and outcome in individuals seeking treatment for substance abuse: A multisite effectiveness study

Carroll¹,

Ball²,

Nich³

et al. 2006

Drug and Alcohol Dependence

412

347

View full text Add to dashboard Cite

show abstract

“…Of the 481 missing urine specimens, 314 (65.2%) were self-reported by patients as positive for cocaine. These figures are comparable to previous studies using self-report data in cocaine dependent samples Hersh, Mulgrew, Van Kirk, & Kranzler, 1999;Zanis, McLellan, & Randall, 1994). This indicated that in this sample, self-reported cocaine use is relatively reliable.…”

Section: Cocainesupporting

confidence: 89%

A double blind, placebo-controlled trial that combines disulfiram and naltrexone for treating co-occurring cocaine and alcohol dependence

Pettinati

Kampman

Lynch

et al. 2008

Addictive Behaviors

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BACKGROUND-This is a double blind, placebo-controlled trial that evaluated the efficacy of disulfiram, naltrexone and their combination in patients with co-occurring cocaine and alcohol dependence.METHODS-208 patients were randomized to disulfiram (250mg/day), naltrexone (100mg/day), the combination, or placebo for 11 weeks. Outcomes were in-trial abstinence from cocaine and/or alcohol.RESULTS-Few safety concerns were reported, although medication adherence was low in a number of patients for both medications, alone or in combination. In the primary analyses (GEE modeling), abstinence from cocaine as measured by cocaine-negative urines and days of self-reported abstinence from cocaine or alcohol did not differ between placebo and any of the medication groups. However, patients taking disulfiram (alone or in combination) were most likely to achieve combined abstinence from cocaine and alcohol. Secondary analyses revealed that patients taking the disulfiramnaltrexone combination were most likely to achieve 3 consecutive weeks of abstinence from cocaine and alcohol.CONCLUSION-There was an association between disulfiram treatment and abstinence from cocaine and alcohol. More patients taking the disulfiram-naltrexone combination achieved 3 consecutive weeks of abstinence in treatment than placebo-treated patients.

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“…Using these cutoffs, 23 urines were submitted that were positive for cocaine when the participant had denied cocaine use in the past 3 days, 31 were positive for marijuana when the participant had denied marijuana use in the past 7 days, and 9 were positive for opioids when the participant had denied opioid use in the past 3 days. This rate is consistent with previous studies of substance-dependent samples (43)(44)(45). Breathalyzer samples were also collected at each assessment visit; none indicated recent alcohol use.…”

Section: Assessmentssupporting

confidence: 88%

Computer-Assisted Delivery of Cognitive-Behavioral Therapy for Addiction: A Randomized Trial of CBT4CBT

Carroll

Ball

Martino

et al. 2008

AJP

370

333

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Objectives-To evaluate the efficacy of a computer-based version of cognitive behavioral therapy (CBT) for substance dependence.Methods-This was a randomized clinical trial in which 77 individuals seeking treatment for substance dependence at an outpatient community setting were randomized to standard treatment or standard treatment with biweekly access to computer-based training in CBT (CBT4CBT).Results-Treatment retention and data availability were comparable across the treatment conditions. Participants assigned to the CBT4CBT condition submitted significantly more urine specimens that were negative for any type of drugs and tended to have longer continuous periods of abstinence during treatment. The CBT4CBT program was positively evaluated by participants. In the CBT4CBT condition, outcome was more strongly associated with treatment engagement than in TAU; further, completion of homework assignments in CBT4CBT was significantly correlated with outcome and a significant predictor of treatment involvement.Conclusions-These data suggest that CBT4CBT is an effective adjunct to standard outpatient treatment for substance dependence and may provide an important means of making CBT, an empirically validated treatment, more broadly available.

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Can you trust patient self-reports of drug use during treatment?

Cited by 96 publications

References 16 publications

Motivational interviewing to improve treatment engagement and outcome in individuals seeking treatment for substance abuse: A multisite effectiveness study

Motivational interviewing to improve treatment engagement and outcome in individuals seeking treatment for substance abuse: A multisite effectiveness study

A double blind, placebo-controlled trial that combines disulfiram and naltrexone for treating co-occurring cocaine and alcohol dependence

Computer-Assisted Delivery of Cognitive-Behavioral Therapy for Addiction: A Randomized Trial of CBT4CBT

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